Paeds Cases · fetal-neonatal-and-perinatal
Maternal disease, medication and substance effects on the fetus — structured clinical encounter
Structured encounter testing pre-conception counselling of a woman on valproate for epilepsy who is planning pregnancy, covering medication switching, folic acid, surveillance and the neonatal plan.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Priya, 24, has juvenile myoclonic epilepsy controlled on sodium valproate. She and her partner attend a pre-conception counselling clinic to plan a pregnancy. She has heard valproate can harm a baby and is anxious.
Station brief (candidate)
You are the general paediatric registrar in a pre-conception counselling clinic. Priya is 24 and has juvenile myoclonic epilepsy, well controlled on sodium valproate for 8 years. She and her partner want to start a family. She has read online that valproate harms babies and arrives anxious, considering stopping her medication. You have 12 minutes with the family and 5 minutes for examiner discussion. [9]
References6ShowHide
- [1]Frias JL, Thomas IT Teratogens and teratogenesis: general principles of clinical teratology. Annals of Clinical and Laboratory Science, 1988.PMID 3289471
- [2]van Gool JD, Hirche H, Lax H, et al. Folic acid and primary prevention of neural tube defects: A review. Reproductive Toxicology, 2018.PMID 29777755
- [9]Tomson T, Landmark CJ, Battino D Antiepileptic drug treatment in pregnancy: changes in drug disposition and their clinical implications. Epilepsia, 2013.PMID 23360413
- [11]Clayton-Smith J, Bromley R, Dean J, et al. Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder; a consensus statement from the European Reference Network for Congenital Malformations and Intellectual Disability. Orphanet Journal of Rare Diseases, 2019.PMID 31324220
- [12]Cummings C, Stewart M, Stevenson M, et al. Neurodevelopment of children exposed in utero to lamotrigine, sodium valproate and carbamazepine. Archives of Disease in Childhood, 2011.PMID 21415043
- [10]Vajda FJ, Hitchcock AA, Graham J, et al. The teratogenic risk of antiepileptic drug polytherapy. Epilepsia, 2010.PMID 19817810